Knowlton Lisa Marie, Arnow Katherine, Cosby Zaria, Davis Kristen, Hendricks Wesley D, Gibson Alexander B, Chen Peiqi, Morris Arden M, Wagner Todd H
From the Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE) (L.M.K., K.A., Z.C., K.D., W.D.H., A.B.G., P.C., A.M.M., T.H.W.); and Department of Surgery (L.M.K., A.M.M.), Stanford University School of Medicine, Stanford, California.
J Trauma Acute Care Surg. 2025 Feb 1;98(2):219-227. doi: 10.1097/TA.0000000000004519. Epub 2024 Dec 20.
Hospital presumptive eligibility (HPE) emergency Medicaid programs offset patient bills at hospitalization and can provide long-term Medicaid coverage. We characterized postdischarge outpatient health care utilization among HPE Medicaid trauma patients and identified patient access facilitators and barriers once newly insured. We hypothesized utilization would be increased among HPE trauma patients compared with other HPE patients, but that challenges in access to care would remain.
We performed a convergent mixed methods study of California HPE beneficiaries using a 2016 to 2021 customized statewide longitudinal claims dataset from the Department of Health Care Services. We compared adults 18 years and older with a diagnosis to other HPE patients. Patients were tracked for 2 months postdischarge to evaluate health care utilization: outpatient specialist visits, emergency room (ER) visits, readmissions, and mental health. Thematic analysis of semistructured interviews with HPE Medicaid patients aimed to understand facilitators and barriers to access to care (n = 20).
Among 199,885 HPE patients, 39,677 (19.8%) had a primary diagnosis of trauma. In the 2 months postdischarge, 40.8% of trauma vs. 36.6% of nontrauma accessed outpatient specialist services; 18.6% vs. 17.2% returned to ED, 8.4% vs. 10.2% were readmitted; and 1.4% vs. 1.8% accessed mental health services. In adjusted analyses, trauma HPE patients had 1.18 increased odds of accessing outpatient specialist services ( p < 0.01). Patients cited HPE facilitators to accessing care: rapid insurance acquisition, outpatient follow-up, hospital staff support, as well as ongoing barriers to access (HPE program information recall, lack of hospital staff follow up postdischarge, and difficulty navigating a complex health care system).
Hospital presumptive eligibility Medicaid is associated with higher rates of outpatient specialist visits and fewer readmissions following injury, suggesting improved trauma patient access. Opportunities to improve appropriateness of health care utilization include more robust and longitudinal education and engagement with HPE Medicaid patients to help them navigate newfound access to services.
Prognostic and Epidemiological; Level III.
医院推定资格（HPE）紧急医疗补助计划可在患者住院时抵消账单，并能提供长期医疗补助覆盖。我们对HPE医疗补助创伤患者出院后的门诊医疗保健利用情况进行了特征描述，并确定了新参保患者获得医疗服务的促进因素和障碍。我们假设与其他HPE患者相比，HPE创伤患者的利用率会有所提高，但获得医疗服务的挑战仍将存在。
我们利用来自医疗保健服务部的2016年至2021年定制的全州纵向索赔数据集，对加利福尼亚州HPE受益人进行了一项收敛性混合方法研究。我们将18岁及以上有诊断的成年人与其他HPE患者进行了比较。对患者出院后2个月进行跟踪，以评估医疗保健利用情况：门诊专科就诊、急诊室就诊、再入院和心理健康情况。对HPE医疗补助患者进行半结构化访谈，并进行主题分析，旨在了解获得医疗服务的促进因素和障碍（n = 20）。
在199,885名HPE患者中，39,677名（19.8%）的主要诊断为创伤。出院后2个月内，40.8%的创伤患者与36.6%的非创伤患者使用了门诊专科服务；18.6%的创伤患者与17.2%的非创伤患者返回急诊室，8.4%的创伤患者与10.2%的非创伤患者再次入院；1.4%的创伤患者与1.8%的非创伤患者使用了心理健康服务。在调整分析中，创伤HPE患者获得门诊专科服务的几率增加了1.18（p < 0.01）。患者列举了获得医疗服务的HPE促进因素：快速获得保险、门诊随访、医院工作人员支持，以及持续存在的获得医疗服务的障碍（HPE计划信息回忆、出院后缺乏医院工作人员随访，以及在复杂的医疗保健系统中导航困难）。
医院推定资格医疗补助与门诊专科就诊率较高和受伤后再入院率较低相关，表明创伤患者获得医疗服务的情况有所改善。提高医疗保健利用适当性的机会包括对HPE医疗补助患者进行更有力和长期的教育与参与，以帮助他们应对新获得的服务机会。
预后和流行病学；三级。
